使用降落伞技术再固定骨软骨片在急性髌骨脱位后获得良好临床和影像学结果：短期至中期随访病例系列
简介
回顾性病例系列纳入20例急性髌骨脱位患者，采用经髌骨可吸收缝线（parachute 技术）固定骨软骨片并联合 MPFL 重建，平均随访62个月。末次随访 Kujala 89.4、IKDC 86.7、KOOS 87.8，95%满意，MRI MOCART 2.0 评分84，翻修率10%，骨软骨整合良好。该技术可靠、简单、单阶段，短期至中期疗效满意，但证据等级IV…
英文摘要
PURPOSE: To evaluate short- to mid-term clinical and radiological outcomes following osteochondral flake refixation with transpatellar, absorbable sutures (parachute technique) combined with concomitant medial patellofemoral ligament (MPFL) reconstruction after acute patellar dislocation. It was hypothesized that the parachute technique would yield favourable clinical and functional outcomes and demonstrate good osteochondral integration on radiographic follow-up. METHODS: A retrospective case series was conducted, including patients who underwent osteochondral flake refixation using the parachute technique following acute patellar dislocation between January 2012 and November 2023 at a minimum follow-up of 24 months. Clinical outcomes were assessed using the Visual Analogue Scale (VAS), Tegner Activity Scale (TAS), Kujala Score, International Knee Documentation Committee (IKDC) subjective score and Knee Injury and Osteoarthritis Outcome Score (KOOS). Radiological outcomes were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 knee score on 3.0-T magnetic resonance imaging (MRI) by three independent raters and intraclass correlation coefficient (ICC) was assessed. RESULTS: Of 26 identified patients, 20 (77%) were available at final follow-up (mean age 20.8 ± 5.3 years; mean follow-up 62.2 ± 20.5 months; mean defect size 2.8 ± 1.5 cm2). Clinical outcome scores resulted in a mean VAS of 0.5 ± 1.6, TAS of 6 (interquartile range 4-7), Kujala Score of 89.4 ± 12.5, IKDC of 86.7 ± 14.3 and total KOOS of 87.8 ± 14.1. Of all patients, 95% were satisfied with the overall result, and 90% would be willing to undergo the procedure again if necessary. Two patients (10%) required revision surgery (one patella re-dislocation, one failed osteochondral integration). The mean MOCART 2.0 score was 84 ± 8 (range: 75-95), indicating good to excellent osteochondral integration. Inter-rater reliability across the three raters was almost perfect (ICC = 0.84; 95% confidence interval 0.79-0.96). CONCLUSION: The parachute technique yields favourable clinical and functional outcomes at short- to mid-term follow-up and demonstrates good to excellent osteochondral integration on MRI following acute patellar dislocation. The technique represents a reliable, simple and single-stage option for the treatment of retropatellar osteochondral flake fractures. LEVEL OF EVIDENCE: Level IV, case series.